Nurse Utilization Nurse Consultant (RN) Job in Chicago, Illinois US
Nurse Utilization Nurse Consultant (RN)
Job Description POSITION SUMMARY This RN performs utilization review and management of bed days on Aetna Medicare members that are hospitalized in Skilled Nursing Facilities, Long Term Acute Care and Acute Rehab units. A major focus of this role is on proactive discharge planning. This RN will partner with the staff of the facility to plan and facilitate a timely and safe transfer of the member to the next appropriate level of care. You will works collaboratively with the Medical Director, Case Managers, Social Workers and provider contacts. -Utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program -Utilize clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for our Aetna Medicare members -Gather clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Proficiency in using CMS guidelines is preferred -Communicate with providers and other parties to facilitate care/treatment -Identify members for referral opportunities to integrate with other products, services and /or programs -Identify opportunities to promote quality effectiveness of Healthcare Services and benefit utilization EDUCATION The highest level of education desired for candidates in this position is an Associate's degree or equivalent experience. LICENSES AND CERTIFICATIONS Registered Nurse (RN) is required Certification in Geriatrics is desired FUNCTIONAL EXPERIENCES Discharge Planning/1-3 Years Concurrent Review/discharge planning/1-3 Years Medical/Precertification/1-3 Years Clinical coverage and policies/1-3 Years Medical Management - Home health care/1-3 Years TECHNOLOGY EXPERIENCES Aetna Applications/eTUMS -Total Utilization Mgmt System Internet/1-3 Years Microsoft Outlook/1-3 Years REQUIRED SKILLS Benefits Management/Interacting with Medical Professionals Benefits Management/Maximizing Healthcare Quality Benefits Management/Supporting Medical Practice DESIRED SKILLS Service/Providing Solutions to Constituent Needs ADDITIONAL JOB INFORMATION This position is available in our downtown Chicago, IL location. Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position. Aetna does not permit the use of tobacco related products or drugs in the workplace.